Nineteen NHS trusts have been referred to ministers after auditors raised concerns about their financial health.

The Audit Commission made the move after reviewing the health of 98 trusts running a combination of hospital, ambulance and community services.

The referrals have been made because the trusts have failed to break even and do not have robust enough plans to balance the books in the coming years.

The number represents nearly a four-fold rise from five last year.

It is another sign of the growing financial problems being seen in the health service. Earlier this month the Nuffield Trust warned that a quarter of trusts had finished the year in deficit, but that included nearly 250 trusts across the whole health service.

The Audit Commission looked in-depth at only those trusts that have not achieved foundation trusts status - given to the elite performers - and, as such, they tend to be the most financially-challenged organisations.

'Worrying'

Overall the watchdog had concerns about a third, but the 19 hospital trusts who got referrals are effectively the ones with the most deeply-rooted problems.

Not only did they fail to break even in 2013-14, but they were unable to convince auditors they could rectify the issues in the medium term.

The referral to Health Secretary Jeremy Hunt means the trusts will face closer scrutiny from the authorities.

One of those referred is Hinchingbrooke, which is the first hospital trust to be run by a private firm, Circle.

Audit Commission controller Marcine Waterman said the findings were "worrying".

A Department of Health spokesman said the government recognised there were challenges which was why the budget had been protected this parliament.

He added: "It is essential that trust chief executives have a tight financial grip and ensure they live within their means."